sub-Saharan African Migrants Research Articles

\u2018A disease like any other\u2019 traditional, complementary and alternative medicine use and perspectives in the context of COVID-19 among the Congolese community in Belgium

BackgroundAs a hard-hit area during the COVID-19 pandemic, Belgium knew the highest mortality among people from sub-Saharan African descent, compared to any other group living in the country. After migration, people often maintain traditional perceptions and habits regarding health and healthcare, resulting in a high prevalence of traditional, complementary and alternative medicine use among different migrant communities in northern urban settings. Despite being the largest community of sub-Saharan African descent in Belgium, little is known on ethnobotanical practices of the Belgian Congolese community. We therefore conducted an exploratory study on the use of medicinal plants in the context of COVID-19 and perceptions on this new disease among members of the Congolese community in Belgium.MethodsWe conducted 16 in-depth semi-structured interviews with people of Congolese descent currently living in Belgium. Participants were selected using purposive sampling. Medicinal plant use in the context of COVID-19 was recorded through free-listing. Data on narratives, ideas and perceptions on the origin, cause/aetiology and overall measures against COVID-19 (including vaccination) were collected. Interview transcripts were analysed using thematic analysis.ResultsFour overarching themes emerged from our data. Firstly, participants perceived the representation of the severity of COVID-19 by the Belgian media and government—and by extend by all governmental agencies in the global north—as exaggerated. As a result, traditional and complementary treatments were seen as feasible options to treat symptoms of the disease. Fifteen forms of traditional, complementary and alternative medicine were documented, of which thirteen were plants. Participants seem to fold back on their Congolese identity and traditional knowledge in seeking coping strategies to deal with the COVID-19 pandemic. Finally, institutional postcolonial distrust did not only seem to lead to distrust in official messages on the COVID-19 pandemic but also to feelings of vaccination hesitancy.ConclusionIn the context of the COVID-19 pandemic, participants in our study retreated to, reshaped and adapted traditional and culture-bound knowledge. This study suggests that the fragile and sensitive relationship between sub-Saharan African migrant groups and other social/ethnic groups in Belgium might play a role in their sensitivity to health-threatening situations, such as the COVID-19 pandemic.

Trust, Sociability, and Quality of Life of Sub-Saharan African Migrants in Germany.

Poor social integration is associated with poor quality of life among minority groups. The current study hypothesized that trust and sociability may significantly explain the quality of life performance among Sub-Saharan African migrants in Germany. Data from 518 migrants were analyzed. Hierarchical multiple linear regression models were calculated to assess the predictive effect of trust and sociability on aggregate quality of life. Results show that general trust and sociability explained about 21% of the variance in quality of life score (adjusted R 2 = .206; p < .001) for the total sample. Socioeconomic and demographic features suggested an added predictive effect of about 8% for total sample (adjusted R 2 = .279; p < .001), 10% for male (adjusted R 2 = .322; p < .001) and 4% for female (adjusted R 2 = .211; p < .001). The results support trust and sociability as essential in connecting to a new environment and enhancing the quality of life.

The effects of colourism on migrant adaptation in Asia: the racial exclusion of African migrants in South Korea’s “multicultural” society

ABSTRACT While high rates of intra-Asian migration have rendered foreign migrants physically “invisible” in the past, migrants of increasingly racially diverse backgrounds have started to enter South Korea in the past decade. Through in-depth interviews with sub-Saharan African migrants, this article examines the effects of colourism on three levels of migrant adaptation: (1) host government legal policies, (2) host societal reception, and (3) resources within the migrant community. Findings reveal that African migrants, compared to their lighter skinned Asian counterparts, are more vulnerable to precarious living conditions regardless of their legal, educational, or occupational backgrounds. In addition, Africans also lack resources in South Korean civil society as well as within the African migrant community, and thus face formidable barriers in collective resistance. Harsh discrimination in everyday life causes many to adopt maladaptive behaviours – resisting linguistic acquisition and adopting a sojourner orientation – triggering a negative feedback loop that exacerbates their oppression.

Restrictive Reciprocal Obligations: Perceptions of Parental Role in Career Choices of Sub-Saharan African Migrant Youths.

This study employed interpretivist, grounded theory method and utilized semi-structured interviews to explore how 31 African migrant high school and university students from eight sub-Saharan African representative countries and currently residing in Townsville, Australia, perceived the roles of their parents in their career development. The study findings revealed that the support (financial, social and emotional) and encouragement (sacrificial love, role modeling and guidance) received from parents underpinned the youths’ perceptions of their parents as influential in their career trajectories. Though participants acknowledged their indebtedness to parents and the system that nurtured them, they faced a dilemma conforming to parental preference or personal conviction, which presented “a fork in the career decision-making road.” Study findings indicate that participants’ reactions and strategies for negotiating parental approval differ based on entry status and gender. Most participants, particularly those with professional entry status, conformed to their parents’ career choice for fear of failure, while a few who followed their personal interests negotiated parental approval through dialogue and educating parents. Male participants with humanitarian entry status opposed their parents’ career preferences and followed their own personal interests. Taken together, all participants had strong desire to obtain parental approval and whether sought early or later, the main focus for all participants was prioritizing family needs and obligations. The practical implications of these findings for all stakeholders are discussed.

The Influence Region of Origin, Area of Residence Prior to Migration, Religion, and Perceived Discrimination on Acculturation Strategies Among sub-Saharan African Migrants in Australia

The study examined whether there was an influence of region of origin, area, or residence prior to migration, religion, and perceived discrimination on the acculturation strategies of sub-Saharan African migrants in Australia. These factors have been found to affect acculturation, given the multi-dimensionality of identify formation. Data were obtained on 425 sub-Saharan African migrants and refugees living in Victoria and South Australia. Acculturation was measured using the Vancouver Acculturation Index. Compared to migrants from central Africa, those from eastern Africa (adjusted odds ratio [AOR], 0.45; p < 0.01) were less likely to assimilate, while migrants who lived in large towns or the city prior to migration (AOR, 0.54; p < 0.05) were less likely to separate but more likely to assimilate (AOR, 2.26; p < 0.01) than those who came from refugee camps. Compared to Muslims, Christians (AOR, 0.57; p < 0.05) were less likely to integrate while those practising religions other than Islam or Christianity (AOR, 3.54; p < 0.01) were more likely to separate. Migrants reporting not fitting in/excluded were less likely to be in the culturally marginalised group (OR, 0.86; p < 0.01) but more likely to report being integrated (AOR, 1.14; p < 0.01), whereas those reporting personal discrimination (AOR, 1.12; p < 0.01) and societal discrimination (AOR, 1.13; p < 0.01) were more likely to separate or remain traditional. In order to promote cultural pluralism and facilitate cultural adaptations among sub-Saharan African migrants, educational programs, anti-racism policy, and legislative reforms need to reposition multiculturalism in a way that promotes tolerance and acceptance of ethnic, cultural, and religious diversity.

Carbohydrate-dense snacks are a key feature of the nutrition transition among Ghanaian adults - findings from the RODAM study.

BackgroundAfrican populations in sub-Saharan Africa and African migrants in Europe are facing a rapid upsurge in obesity. This trend has been related to urbanization, migration and associated shifts in lifestyle, including dietary habits. Whether changes in eating patterns contribute to the rising burden of obesity among African populations is currently unknown.ObjectiveOur aims in conducting this study were to characterize eating patterns among Ghanaian adults living in their country of origin and in Europe and to explore associations of meal patterns with body mass index (BMI).DesignWithin the cross-sectional RODAM (Research on Obesity and Diabetes among African Migrants) study, data of single 24-h dietary recalls from Ghanaian adults in rural Ghana (n = 20), urban Ghana (n = 42), and Europe (n = 172) were recorded. Eating frequencies, energy intake, and macronutrient composition of eating occasions (EOs, i.e. meals or snacks) were compared between study sites based on descriptive statistics and χ2-/Kruskal–Wallis tests.ResultsA rising gradient of EO frequencies from rural Ghana through urban Ghana to Europe was observed, mainly reflecting the differences in snacking frequencies (≥1 snack per day: 20 vs. 48 vs. 52%, P = 0.008). Meal frequencies were similar across study sites (≥3 meals per day: 30 vs. 33 vs. 38%, P = 0.80). Meals were rich in carbohydrates (median 54.5, interquartile range (IQR): 43.2–64.0 energy%) and total fats (median: 27.0, IQR: 19.9–34.4 energy %); their protein content was lowest in rural Ghana, followed by urban Ghana and Europe (P = 0.0005). Snacks mainly contained carbohydrates (median: 75.7, IQR: 61.0–89.2 energy%). In linear regression analyses, there was a non-significant trend for an inverse association between snacking frequencies and BMI.Discussion and conclusionsThe observed integration of carbohydrate-dense snacks into the diet supports the growing evidence for a nutrition transition among African populations undergoing socioeconomic development. This analysis constitutes a starting point to further investigate the nutritional implications of increased snacking frequencies on obesity and metabolic health in these African populations.

The Association between Post-Migration Nutrition and Lifestyle Transition and the Risk of Developing Chronic Diseases among Sub-Saharan African Migrants: A Mixed Method Systematic Review Protocol.

Sub-Saharan African (SSA) migrants face nutrition and lifestyle changes upon arrival in a host country. The shift in diet and lifestyle reflects post-migration acculturation and could predispose migrants to nutrition- and lifestyle- related chronic diseases. A mixed-methods systematic review of published studies and the grey literature on post-migration nutrition and lifestyle transition among SSA migrants will be undertaken. Studies published in English and conducted from 2000 to 2020 using quantitative and/or qualitative methods will be included. Ten bibliographic databases will be searched: Scopus, Ovid MEDLINE, EMBASE, Global Health, CINAHL, PubMed, ProQuest, PsycINFO, Informit and Web of Science. Data extraction will be informed by the Cochrane PROGRESS-Plus framework and the Joanna Briggs Institute manual. The quality of the included studies will be appraised for risk of bias using validated tools. An integrated approach to quantitative and qualitative data synthesis through data transformation will be undertaken, and a narrative synthesis of the findings will be provided. This protocol is guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines and provides insight into the scope and parameters of the systematic review to be conducted. The aim of the review is to evaluate the association between post-migration nutrition and lifestyle transition and the risk of developing chronic diseases among SSA migrants in Australia. This review will provide insight into possible areas for interventions to improve the health of migrants. Systematic Review Registration: The protocol was registered with the PROSPERO international prospective register of systematic reviews CRD42020206560.

Association between Practising Religion and Cardiovascular Disease Risk among Ghanaian Non-Migrants and Migrants in Europe: The RODAM Study.

(1) Background: Sub-Saharan African migrants residing in high-income countries are more affected by cardiovascular diseases (CVDs) and associated risk factors than host populations for unclear reasons. The aim was to explore the associations of religion and religious affiliations with CVD risk among Ghanaian non-migrants and migrants in Europe. (2) Methods: The 10-year CVD risk was estimated using pooled cohort equations for 3004 participants from the cross-sectional Research on Obesity and Diabetes among African Migrants (RODAM) study. Logistic regression analyses were conducted to assess associations between religion and elevated CVD risk (score ≥ 7.5) with adjustment for covariates. (3) Results: Religious men in Europe had a lower 10-year CVD risk compared with non-religious men (adjusted OR 0.51; 95% confidence interval 0.30–0.85), specifically men affiliated with Seventh-Day Adventism (0.24; 0.11–0.53) followed by other affiliations (0.32; 0.11–0.94) and Roman Catholicism (0.42; 0.21–0.86). The opposite was found in Ghana, with religious women having higher odds for elevated 10-year CVD risk (1.53; 1.02–2.30) compared with their non-religious counterparts, specifically women affiliated with Reformed Christianity (1.73; 1.03–2.90) and other denominations (2.81; 1.20–6.54). Associations were not significant for men in Ghana and women in Europe. Adjustments for social support, stress, and health behaviors did not meaningfully alter the associations. (4) Conclusions: Christian religious Ghanaian men living in Europe seem to have lower CVD risk compared with their non-religious counterparts, while Christian religious women in Ghana appear to have increased CVD risk. Further unravelling the contributing factors and the differences between sex and environmental settings is needed.

Tacking towards freedom? Bringing journeys out of slavery into dialogue with contemporary migration

ABSTRACT Antislavery actors evoke the history of the transatlantic slave trade in campaigns to mobilise action to address the suffering experienced by contemporary migrants described as ‘victims of trafficking’. That framing has been picked up by state actors who present measures to supress unauthorised migration per se as necessary to protect migrants from a ‘modern-day slave trade’. Yet the parallel between trafficking and the slave trade is undermined by the fact that people who today are described as ‘trafficked’, as much as those described as ‘smuggled’, actively wish to travel and do so in the hope that by moving, they will secure greater freedoms. This article therefore asks whether there are similarities between the journeys of contemporary unauthorised migrants and those of enslaved people who fled from slavery in the Atlantic World, and if so, why. Bringing data from historical sources on slave flight into dialogue with data on the journeys of contemporary sub-Saharan African migrants to Europe and Brazil, it identifies a number of experiential parallels, and argues that for those concerned with migrants’ rights, enslaved people’s fugitivity potentially offers a more fruitful point of historical comparison than does the slave trade.

Depression Mediates Association Between Perceived Ethnic Discrimination and Elevated Blood Glucose Levels Among Sub-Saharan African Migrants in Australia.

Depression and perceived ethnic discrimination (PED) are both implicated in type 2 diabetes mellitus (T2DM) risk in some migrant populations. The role of these factors remains understudied in sub-Saharan African migrants, who comprise a significant at-risk group for T2DM in Australia. To assess interactions between PED, depression scores and elevated blood glucose levels among sub-Sahara African immigrants in North-Eastern Australia. Face to face surveys were used to assess PED and depressive tendencies in a purposive sample of 170 adults (aged ≥18year). Fasting blood glucose levels (FBGL) were measured at the time of interviews. Prevalence of elevated FBGL (≥6.1mmol/L), PED and severe depression (SD) were: 17.6% (n = 30), 14.7% (n = 25) and 18.8% (n = 32), respectively. Prevalence of elevated FBGL, PED and SD were all higher in males than females. The highest prevalence of elevated BGL, PED and SD each occurred in the 40-50year age group. Strong positive correlations of both high level PED and SD with elevated FBGL were observed. There was also a strong positive association between PED and SD. Depression score was found to mediate partially the strong association between PED and elevated FBGL (β-value for PED dropped from β = 0.452 to β = 0.246, p < 0.01 and the associated between FBGL and SD remained strong β = 0.554, p < 0.01). The strong association between elevated FBGL and PED seems to be moderated by SD, indicating that interventions to attenuate depression and PED may be a useful adjunct to diabetes prevention programs in this population. Interventions targeted to specific age groups may also be warranted.

Inequalities in Psychiatric Service Use and Mortality by Migrant Status Following a First Diagnosis of Psychotic Disorder: A Swedish Cohort Study of 1.3M People.

It is unclear whether inequalities in mental healthcare and mortality following the onset of psychosis exist by migrant status and region-of-origin. We investigated whether (1) mortality (including by major causes of death); (2) first admission type (inpatient or outpatient); (3) in-patient length of stay (LOS) at first diagnosis for psychotic disorder presentation, and; (4) time-to-readmission for psychotic disorder differed for refugees, non-refugee migrants, and by region-of-origin. We established a cohort of 1 335 192 people born 1984–1997 and living in Sweden from January 1, 1998, followed from their 14th birthday or arrival to Sweden, until death, emigration, or December 31, 2016. People with ICD-10 psychotic disorder (F20–33; N = 9399) were 6.7 (95% confidence interval [95%CI]: 5.9–7.6) times more likely to die than the general population, but this did not vary by migrant status (P = .15) or region-of-origin (P = .31). This mortality gap was most pronounced for suicide (adjusted hazard ratio [aHR]: 12.2; 95% CI: 10.4–14.4), but persisted for deaths from other external (aHR: 5.1; 95%CI: 4.0–6.4) and natural causes (aHR: 2.3; 95%CI: 1.6–3.3). Non-refugee (adjusted odds ratio [aOR]: 1.4, 95%CI: 1.2–1.6) and refugee migrants (aOR: 1.4, 95%CI: 1.1–1.8) were more likely to receive inpatient care at first diagnosis. No differences in in-patient LOS at first diagnosis were observed by migrant status. Sub-Saharan African migrants with psychotic disorder were readmitted more quickly than their Swedish-born counterparts (adjusted sub-hazard ratio [sHR]: 1.2; 95%CI: 1.1–1.4). Our findings highlight the need to understand the drivers of disparities in psychosis treatment and the mortality gap experienced by all people with disorder, irrespective of migrant status or region-of-origin.

Stock Inka, Time, Migration and Forced Immobility. Sub-Saharan African Migrants in Morocco

Le Maroc etait autrefois un pays que beaucoup de personnes en provenance d’Afrique subsaharienne traversaient en direction de l’Europe. Plus recemment, pourtant, la continuation de ce trajet a ete rendue difficile, voire meme impossible, a cause de l’intensification du controle aux frontieres exterieures de l’Union europeenne. L’ouvrage Time, Migration and Forced Immobility. Sub-Saharan African Migrants in Morocco, ecrit par la sociologue Inka Stock, part donc d’un paradoxe : alors que les ac...

Canada’s Sub-Saharan African migrants: A scoping review

Despite the recent increase in Sub-Saharan African newcomers to Canada, little is known about their experiences, specifically the challenges they face rebuilding their lives and the strategies they adopt to tackle these challenges. This scoping review of 48 articles provides a critical basis for further research on Sub-Saharan African international migration to Canada. Five themes emerged from the extant literature: 1) structural barriers to rebuilding self, family, and community; 2) limited support systems available in the transition period; 3) transnational ties and commitments as a recurring mediator of migrant life; 4) mechanisms for navigating transition and integration; and 5) changing gender relations and roles. Findings across these themes strongly project gender relations as a crucial engine of migrant life, yet studies do not extensively probe the nature and dynamics of key facets of post-migration gender relations. While transnational linkages could provide some support and sense of identity, the demands of and commitments to extended family members and other entities could stall or undermine efforts to rebuild lives and community in a new homeland. The coping mechanisms identified here appear to relieve or postpone the consequences of Sub-Saharan African migrants’ adaptations to the realities of life in Canada. Our review also underscores the need for strength-based approaches, such as resilience, in exploring the experiences of Sub-Saharan African migrants as newcomers in advanced Western nations like Canada. Future studies should consider that international migration presents complex challenges to both migrant sending and receiving countries, traceable to both localized and transnational historical and social linkages.

Post-migration well-being of Sub-Saharan Africans in China: a nationwide cross-sectional survey.

This study aims to understand the quality of life (QOL) among Sub-Saharan African (SSA) migrants and explore the factors that contribute to and shape SSA migrants' QOL and shed light on how post-migration factors affect their QOL in China. We conducted a nationwide cross-sectional survey on QOL of SSA migrants in China from August, 2019 to November, 2019. We recruited SSA migrants using a combination of peer-referred online and offline surveys. The WHOQOL-BREF scale assessed the QOL of participants, and depressive symptoms were measured using Center for Epidemiologic Studies-Depression scale. Correlates of well-being including depressive symptoms, migration-related factors, and socio-demographic characteristics were included in hierarchical linear regression models to explore the contributions of these factors on QOL of SSA migrants. This study included 928 eligible SSA migrants. The total score of the WHOQOL-BREF scale was 66.8 ± 14.0. Attitudes of local people toward SSA migrants (β = 3.1, 95% CI 2.4, 3.0) and satisfaction with their living conditions (β = 3.6, 95% CI 2.5, 4.7) were positively associated with QOL and explained 12.2% of the variance. Contracting an infectious disease in the past year (β = -5.3, 95% CI -7.6, -2.9) and depression werenegatively associated with QOL (β = -0.7, 95% CI -0.7, -0.6) and explained 24.4% of the variance. Our study underscores the importance of several key factors that may aid in the improvement of QOL among SSA migrants. Post-migration environmental factors emerged as key correlates of QOL, which builds on previous evidence that the post-migration context should be improved to safeguard the well-being of SSA migrants in China.

Evolution of migration trajectories and transnational social networks over time: a study among sub-Saharan African migrants in Europe

ABSTRACT The transnational social networks of migrants are extensively studied, but little is known about the associations between transnational social networks and individual migration trajectories over the course of migrants’ lives. In this paper, we reconstruct the migration trajectories and transnational social networks of African migrants until their arrival in Europe and develop a typology that reflects the diversity of their trajectories. Based on unique retrospective life-history data of the MAFE project, our comparative perspective highlights the diversity of African migrants residing in Europe, the routes that they took before arriving in Europe and the types of transnational networks they had before, during and after migrating. Furthermore, we discuss the socio-demographic and socio-economic characteristics of migrants within each typology. Consequently, this paper challenges the singular African migration stereotype and draws attention to the associations between transnational social networks and migration trajectories.

Risk for HIV acquisition among sub-Saharan African migrant travelers in Belgium and Portugal

Abstract Migrants often travel back to the origin countries and to other European states after settling in the residence country. Mobility along with structural vulnerabilities may increase HIV acquisition risk. Knowledge on HIV risk exposure when traveling is limited, yet crucial to inform prevention. This study aims to explore risky sexual behaviors and assess HIV prevalence among sub-Saharan African migrants (SAMs) who travel, residing in two European cities. Two cross-sectional biobehavioral surveys were conducted in Lisbon and Antwerp with a venue-based sample of 1508 SAMs. Descriptive and multivariable logistic regression analyses were performed to examine travel patterns and associated sexual risk behaviors. Overall, 68.4% of participants had traveled to other countries after settling in the residence country; 41% had traveled back to Africa and within Europe, 25.2% only to Africa and 33.8% only to Europe. Among travelers who reported sexual encounters abroad (49.2%), condomless sex at last intercourse was high both abroad (62.5%) and in the host country (70.7%). Odds of condomless sex at the last sexual encounter in the host country were five times higher among those who also reported no condom use abroad [OR: 5.32; 95% CI: 2.98-9.25], controlling for gender, age, educational level, relationship status, survey country, partner type and origin, and number of sexual partners over the last year. Condomless sex was higher with a regular partner and with an African partner, both abroad (79.9% and 67.5%, respectively) and in the host country (81.3% and 74.6%, respectively). Among the 75 participants who tested HIV-positive (around 5%), more than half had travelled to other countries; of these, about half reported condomless sex with their last sexual partner abroad. SAMs are a mobile population and are exposed to sexual HIV risk both while traveling and in host countries. Prevention interventions should address the complex interplay between migrants' mobility and HIV risk. Key messages Migrants often travel to their origin home countries and other destinations after having settled in host countries, and this mobility increases exposure to HIV risk. A transnational perspective on HIV prevention and sexual health promotion is needed for effectively reducing migrants’ HIV risk related to their mobility.

Hospital STI prevention scheme adapted to target undiagnosed LGBT migrants in Paris area since 2018

Abstract Background In Île-de-France region, 10 000 people do not know they are living with HIV (Supervie, 2016). 70% are men, including 40% men having sex with other men (MSM) and 40% sub-Saharan African migrants. From 35% to 49% of those sub-Saharan African migrants are infected in France. The main HIV prevention issues is to target populations that are unrepresented in screening test centers. Methods To achieve these aims, a sexual health promotion scheme has been designed by a public health association, a Sexual Transmitted Infections (STI) center and an association supporting people asking asylum because of their “sexual orientation or gender identity”. Outreach STI screening test actions are organized monthly in places crowded by asylum seekers and associative sexual health consultation including screening, results reporting, treatments, vaccinations and Pre-Exposition Prophylaxis (PrEP), devoted to asylum seekers are taking place weekly into the hospital. Pear community members have been trained to be referent in health matters and enhance the scheme effectiveness. Results 549 people were screened for STI through 110 actions from March 2018 to December 2019, of which 25 were outreach and 85 inside the hospital. 74% were from sub-Saharan Africa and 86% were presumed MSM. 89% were under 40 years old. 20% of the screened people were diagnosed positive to at least one STI and 52 people have been engaged in PrEP treatment after a risky assessment. Pear referent involvement reduced the number of unreported results, 10% are still unreported. 21 people have stopped PrEP follow-up. Around 3/4 of those followed by the association on the period stand unreached. Conclusions The scheme allowed to targeted population according to epidemiology's indicators but we don't know if the most exposed part of the population is reached. Partnership between associations and hospital improved public health system as well as community involvement. Key messages Public health system needs adaptations to struggles epidemics. Community involvement must be a priority to increase prevention’s efficiency .

Correlates of HIV, STI and TB among sub-Saharan African migrants in Lisbon: a biobehavioral study

Abstract Sub-Saharan African migrants (SAMs) have been disproportionately affected by infectious diseases such as HIV, other sexually transmitted infections (STIs) and Tuberculosis infection (TB). Research on infectious diseases and related factors among migrant populations is critical to further understand these populations' health needs and inform prevention strategies. However, migrants are often underrepresented in national statistics and research. This study aimed to examine correlates of HIV, past STI and past TB among SAMs. A venue-based sample of 790 SSAMs completed a cross-sectional biobehavioral survey on sexual practices, HIV testing and self-reported infectious diseases; an HIV rapid test was offered. Uni- and multivariable logistic regression analyses were performed to examine factors associated with HIV, past STI and past TB. Overall, 5.4% of participants were HIV-positive and 16.7% reported a past STI. Odds of being HIV positive increased by age (OR 1.07, 95%CI 1.03-1.11) and were higher among those who experienced violence from a partner (OR 2.77, 95%CI 1.08-7.10). Increased odds of having a past STI were found among migrants with low income (OR 2.86, 95%CI 1.48-5.56), long-term migrants (&amp;gt;25 years residing in Portugal: OR 2.16, 95%CI 1.06-4.38) and those who reported sexual risk behaviors (≥3 sexual partners: OR 2.06, 95%CI 1.14-3.70; inconsistent condom use: OR 2.61, 95%CI 1.32-5.17). In total, 4.1% of participants had TB in the past; these were more likely male (OR 3.42, 95%CI 1.29-9.06) and HIV positive (OR 11.48, 95%CI 4.55-28.94). Half of the participants had never been tested for HIV before, including over a third of those who had STI or TB in the past. Efforts are needed to reduce missed opportunities for HIV/STIs prevention and uptake of HIV testing among SSAMs through more integrated care, while addressing social determinants of infectious diseases. Key messages High levels of HIV, STI and TB infection among SAMs were found to be strongly associated with socioeconomic disadvantage and poor living conditions in the host country. Social inequalities are persistently a major factor affecting risk for HIV, STIs and TB, and thus addressing social determinants of infectious diseases must remain a public health priority.

Development and Evaluation of an HIV-Testing Intervention for Primary Care: Protocol for a Mixed Methods Study.

BackgroundLate diagnosis of HIV fosters HIV transmission and may lead to hidden HIV epidemics. In Belgium, mathematical modeling indicates a high prevalence of undiagnosed HIV infections among men who have sex with men of non-Belgian origin and among sub-Saharan African migrants. Promotion of HIV testing facilitates early diagnosis, but diagnostic opportunities are missed in primary care.ObjectiveThe intervention study aims to enhance provider-initiated HIV testing by GPs. This protocol presents the conceptual development, implementation, and evaluation of an HIV-testing intervention for Flemish general practitioners (GPs).MethodsA mixed methods evaluation design is used. Guided by a simplified intervention mapping approach, an evidence-based intervention was developed in collaboration, guided by an interdisciplinary advisory board. The intervention consisted of an evidence-based tool (ie, “HIV-testing advice for primary care”) to support GPs in provider-initiated HIV testing. A modified stepped-wedge design compare two different intervention levels: (1) online dissemination of the HIV-testing advice and (2) dissemination with additional group-level training. Both conditions were compared against a control condition with no intervention. The effect of the intervention was measured using Poisson regression for national surveillance data. The primary outcome was the number of HIV diagnoses made by GPs. Secondary outcomes were HIV diagnoses among groups at risk for undiagnosed HIV, distribution of new diagnoses by CD4 cell count, number of HIV tests prescribed by GPs, and rate of new diagnoses by tests. To evaluate the intervention’s implementation, the GPs’ fidelity to the intervention and the intervention’s feasibility and acceptability by GPs were assessed through (web-based) surveys and in-depth telephone interviews.ResultsThe study was funded in 2016 and ethically approved in January 2017. The implementation of the intervention started in January 2017 and ended in December 2018. Data was completed in October 2019 and was the starting point for the ongoing data analysis. The results are expected to be published in the second half of 2020.ConclusionsResults of the intervention study will provide useful information on the intervention’s effectiveness among Flemish GPs and can inform further development of official testing guidelines. Limitations of this real-life intervention approach are potential spill-over effects, delay in access to surveillance data, and little detailed information on HIV-testing practices among GPs.Trial RegistrationClinicalTrials.gov NCT04056156; https://clinicaltrials.gov/ct2/show/NCT04056156International Registered Report Identifier (IRRID)DERR1-10.2196/16486

Community-Level Postmaterialism and Anti-Migrant Attitudes: An Original Survey on Opposition to Sub-Saharan African Migrants in the Middle East

AbstractWhy do native citizens of the Middle East and North Africa express greater opposition to certain types of migrants, refugees, and displaced persons? Why, particularly, do they express greater opposition to sub-Saharan African migrants? This article investigates these questions, leveraging results from an original, nationally representative survey of 2700 native Moroccan citizens. We find support for traditional theories, mostly developed from studies of Western Europe, that hypothesize that the perceived cultural, economic, and security threats migrants pose provoke citizen opposition to certain migrant subtypes. Diverging from past research, however, we argue that the importance of these threats waxes and wanes dramatically at the subnational level due to variation in community-level postmaterialism. In areas where economic development is high, and many citizens live in European-style conditions, postmaterialism—preoccupation with cultural, identity, and security-based concerns—helps to predict greater citizen opposition to sub-Saharan African migrants. However, in areas where economic development is low, and many citizens do not live like Europeans, this greater opposition to African migrants derives from economic concerns, notably job competition. While postmaterialism is considered an individual-level phenomenon, our work highlights its importance at the community level: The personal circumstances of citizens and the circumstances of the community in which they live interact to condition which perceived threats become more (or less) important to explaining anti-migrant attitudes.